Organization Active NPI

Family Services of NW PA

  • Child & Adolescent Psychiatry Physician
  • Erie, PA
National Provider Identifier
1265482863
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
FAMILY SERVICES OF NW PA
Practice address
5100 Peach St
Erie, PA 16509-2482
Phone
(814) 866-4500
Fax
(814) 864-2677
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven Gresh
Title
Cfo
Phone
(814) 866-4504

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

5100 Peach St
Erie, PA 16509-2482

Mailing address

5100 Peach St
Erie, PA 16509-2482
Phone (814) 866-4500

Other identifiers 2

IdentifierTypeStateIssuer
1007436350006MedicaidPA
BLUE SHIELDOtherPA631888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040802000514 PA Part B Supplier - Clinic/Group Practice 6608847066 Receives reassigned benefits from 7 practitioners
Practice locations: Union City, PA; Erie, PA; Sharon, PA; Meadville, PA

National Provider Directory

National Provider Directory

Locations

235 E 11th St
Erie, PA 16503
Phone (814) 866-4545

5100 Peach St
Erie, PA 16509
Phone (814) 866-4500

1720 Holland St
Erie, PA 16503
Phone (814) 453-6073

18360 Technology Dr
Ste 200
Meadville, PA 16335
Phone (814) 724-4800

13378 Dunham Rd
Meadville, PA 16335
Phone (814) 866-4500

7 W State St
Ste 208
Sharon, PA 16146
Phone (724) 704-7227

38 N Main St
Union City, PA 16438
Phone (814) 866-4500

105 Concord St
Union City, PA 16438
Phone (814) 790-2628

91 Miles St
Union City, PA 16438
Phone (814) 790-2628

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1265482863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092482",
            "telephone_number": "814-866-4500",
            "fax_number": "814-864-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092482",
            "telephone_number": "814-866-4500",
            "fax_number": "814-864-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SERVICES OF NW PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "GRESH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-866-4504"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007436350006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "631888",
            "identifier": "BLUE SHIELD",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.